Saturday, September 8, 2012

As physicians and surgeon we are trained to withstand extremes of adversities inside and outside the operating rooms. Through long years of training we remain focused on the science and art of medicine as applicable to our patients. We all have stayed away from our loved ones during the long years of medical or surgical residency. Subsequently we go through a stringent written and a grilling oral examination to obtain the final Board Certification. In a complex field like Cardiac Surgery this training may be inadequate to practice independently. Therefore many of us underwent low paid concentrated training in a high volume center to sharpen our skills. In Cardiothoracic Surgery this could take anywhere from 13 to 17 years of our lives. How does one react to the decision of the hospital administration to grant Exclusive Contracts to a group of surgeons that excludes you from practicing the art that took a lifetime to master. The Certification of American Board of Thoracic Surgery or State Board Licensure seems to have no meaning if the recipient cannot practice the chosen art freely. While Exclusive Contracts may be legal, they are unjust and unethical. The Hospital CEO’s are completely justified in granting Exclusive Contracts provided they are done scrupulously to serve the patients and not the privileged group of physicians. Therefore the CEO’s must think harder and deeper before granting Exclusive Contracts. While taking all the factors into consideration they must use appropriate moral compass to guide such decisions exclusively in the best interest of the patients. --

With recent restructuring of the health care delivery systems, a number of physicians are either employed or have strong financial ties with the hospital. Hospitals perceive a benefit in giving exclusive privileges to a group of physicians in the form of Exclusive Contracts which prohibits other equally qualified physicians from practicing their science and art. In a field like Cardiac Surgery, although competition is effectively eliminated by an Exclusive Contract, it does not necessarily benefit the privileged group of surgeons. On many occasion the hospital and the surgeons lose a referral due to non- availability of the surgeon from the privileged group. In general any special privileges are un-american and inherited from Old World systems of government. While Department of Justice allows such Exclusive Contracts, in my personal opinion, for certain individuals to have exclusive privileges granted to them by law to exercise any art, trade, or profession, with all the advantages derived from it, whilst other equally competent and as well qualified should be debarred therefrom, is not only unjust towards the public at large, but that it lays the foundation for an odious monopoly with all its dictatorial and dogmatic power. No art or science could be benefited in this way, and the security and monopoly conferred by such legal protection would tend to beget indifference and carelessness that would effectually serve to produce a retrograde rather than a progressive effect. Therefore all reasonable Cardiac Surgeons and physicians must speak out against the unjust practice of Exclusive Contracts in order to protect our freedom to serve our patients unfettered from outside pressures.

Recently the medical executive committee of a prominent local hospital made a decision that only one group of cardio-thoracic surgeons should be allowed to practice at the hospital. This decision was made without any input from the excluded cardiothoracic surgeon, who was left to his own devices. Vested self-interest of the favored group was never taken into consideration. With the advent of Affordable Care Act, such scenarios are going to be commonplace. While such exclusive contracts may not be ethical, they are considered legal by DOJ. Therefore Medical Executive Committee must identify and manage the physician opinions and vested interests regarding each issue that comes before it and not allow one group’s self -interest to take precedence over others. In such challenging times, MEC must seek virtue of Solomonic sapientia in charting a course that balances the needs of all physicians on the medical staff to succeed while not forgetting that patients are the center of the medical universe.